How Will Africa Protect the Next Generation?

When I was at the fifth Africa population conference in December it became even clearer, if it wasn't already, that focusing on youth's reproductive health services will help Africa move forward in development.

Unfortunately as the researchers present their facts and figures, it's clear that the fact that PEPFAR funds expect governments to focus solely on abstinence when dealing with youth is having serious implications on Africa's largest population — which is concentrated in the 15-24 age group.

In 2003, President George W. Bush announced the Emergency Plan for AIDS Relief, a five-year, $15 billion U.S. government initiative that aims to provide treatment to at least two million HIV-infected individuals, prevent seven million new HIV infections, and provide care and support to 10 million people living with and affected by HIV/AIDS, including orphans and vulnerable children.

To help achieve these goals, the U.S. government is rapidly expanding its programs and engaging new partners in 15 focus countries, including Kenya. Under the Emergency Plan, Kenya received nearly $92.5 million in Fiscal Year (FY) 2004, more than $142.9 million in FY 2005, approximately $208.3 million in FY 2006 and are providing $368.1 million in FY 2007 to support comprehensive HIV/AIDS prevention, treatment and care programs.

But according to the Population Action International presentation in Arusha for the conference, a third of these funds are meant for the promotion of abstinence-only. In Uganda the funds have been used to train 46,000 teachers to promote abstinence-only. All adolescents are required to sign virginity pledges and that's all the information they get.

If these funds are meant for prevention, it is clear that prevention is not virginity. One needs to know what to do the first time they have sex — whether it's the twenty-first year, forty-first year or the one hundredth year.

Rosemary Muganda, the director of the Center for the Study of Adolescents said, "its like walking with into a hospital ward with different patients and using one prescriptions for all of them."

Although this is not an article intended to bash PEPFAR, I think we need to be realistic and deal with the real issues on the ground. The age at first sexual encounter for most Ugandan girls and boys is 12-14 years. If HIV/AIDS is to be prevented, these same adolescents need to have information on how to protect themselves from this and any other disease.

"[PEPFAR] is a good initiative but it may end up reducing the impact on prevention for young people," says Muganda.

PEPFAR funds have supported many African governments, including Kenya, in acquiring anti-retrovirals. At the same time, Africa's population is young and the challenges in reproductive health are high. African governments need to prioritize funding to focus on the need of youth.

But as the debate rages, I am wondering whether allowing adolescents access to condoms is a matter of national security for the US government. New data from Burkina Faso, Ghana, Malawi and Uganda reveal that many adolescents do not use contraceptives, have experienced unwanted sex, have multiple or much older partners and, worse still, lack adequate knowledge about avoiding sexually transmitted infections (STIs) and pregnancy.

The new research findings, jointly conducted by the Guttmacher Institute, APHRC and local research partners, suggest a number of important steps that should be taken to help adolescents avoid unwanted pregnancy, STIs and HIV/AIDS. Encourage the use of modern contraceptive methods and make male condoms widely available.

Its also important that we ensure all adolescents have the specific information and skills they need. Although highly aware of sexual reproductive health issues, adolescents still lack skills needed to protect themselves against HIV, unintended pregnancies and unwanted sex. They must be provided with comprehensive information and skills if they are to delay their sexual debut, resist pressure to engage in unwanted sex and practice safe sex.

Given that among 12-14 year olds, 7-34% have experienced some form of physical activity (kissing, fondling or intercourse) or have a boyfriend or girlfriend, and 11-53% have at least one close friend who has had sex, its imperative that interventions start early.

Its also important to note that all adolescents need access to sexual and reproductive health information and services. However, some groups of adolescents, such as out of school youth and married females, have particular needs or face elevated risks and they require targeted solutions.

According to Dr. Eliya Zulu of the Africa Population and Health Research Center (APHRC), "African governments and people working in programs should stand firm on the knd of funding they get so that they are tailored towards the needs of the African adolescents."

Justin Malawezi, former Malawian vice-president thinks believes strongly that a true sign that the war on HIV/AIDs is being won, is when there will be a decline in new infections. He said that once we understand what drives the epidemic among the youth then we will begin to solve the mystery. He suggests the use of traditional forms of communication and passing of information would be a good starting point.

It was apparent in the discussions after the presentations of the result that most people are still uncomfortable with teaching sex education in schools or to adolescents that they feel are too young to be having sex anyway! One wonders then where will the youth run too?

The US guidance contends that providing adolescents with information about both abstinence and contraception sends a "confusing" and "conflicting message" that "appears to encourage sexually activity" despite clear evidence to the contrary. African governments, on the other hand, are still taking donor funding with conditions that they know very well do not work with their situation and meanwhile the youth are stuck with inadequate information, lack of services, high HIV infections and unwanted pregnancies and nervous parents who have refused to bite the bullet and talk to their children about sex and how to prevent themselves from the consequences of sex.